Monday, August 29, 2016

Expected Results From Hormone Therapy In Trans Men and Women

Hormone Therapy For Trans Men and WomenI would like to talk a little about what hormones can and cannot do for someone who is transitioning. I think the first thing is to point out that hormone replacement therapy (HRT) is not some magic pill for transsexuals that makes everything better. The purpose of HRT is to develop secondary sex characteristics associated with ones gender identity thus helping the individual feel more comfortable with their own body. Also it must be noted that HRT can be very dangerous! More on the risks here: mtf and ftm. Lastly, for some people, particularly non-opt or pre-opt people it will not help hide external genitalia. Trans women will still need to tuck if they so choose, and trans men will still need to bind their breasts if they choose to as well.

Note that my intent here is to give a brief overview and this information is to serve only as a guide. Everyone is different and everyone has different results at different times. The effects listed below occur in varying amounts and some people do not experience all of these results in their entirety. Generally speaking, the less time that has passed since puberty the better one's response will be to HRT. The best way to get answers to what hormones can or cannot do for you is to consult your doctor.

That being said, here are some of the effects that can be expected when taking hormones...

HRT for trans women may...

  • Irreversible breast development
  • Irreversible nipple enlargement
  • Redistribution of body fat into a more feminine appearance
  • Decrease in muscle mass
  • Decrease in the appearance of veins
  • Thinning of the skin
  • Increased sensitivity to touch
  • Lessening of body hair
  • Slowed progression or a complete stop in male pattern baldness
  • Decreased in the size of ones testicles
  • Decrease in the number of (or the elimination of) morning erections
  • Decreased libido

What does not happen?
  • Estrogen does not effect one's beard growth. (Read more about hair removal here)
  • Estrogen does not regrow hair that has been lost due to male pattern baldness
  • Estrogen does not effect once vocal pitch
  • Estrogen does not change one's bone structure. While some fat is redistributed you will not magically gain hips. For those interested there are hip enhancement options!

HRT for trans men may...

  • Redistribution of body fat into a more masculine appearance
  • Increase in muscle mass
  • Increase in acne
  • Increase in body hair
  • Beard growth
  • Lowering of voice pitch
  • Cessation of menstrual cycle
  • Increase in the size of the clitoris
  • Increased libido

What does not happen?
  • Testosterone does not reverse breasts or nipple development
  • Testosterone does not change one's bone structure

General Questions

What are the risks of taking hormones?
This should be discussed with your doctor but I will say this... These chemicals are no joke so please do not attempt to self medicate. YOU CAN DIE! I also have a fairly in depth article for both mtf and ftm HRT risks.

Does you personality change after taking hormones?
From what I have read and what I have been told the answer is no. From experience it is a bit unclear. I know that I am not the same person I was when I started hormones but is it a correlation? I don't know. My gut says yes.

I find it more likely that as I become more comfortable with myself in my transition I am more comfortable expressing myself the way that I want. I also cannot discredit the notion that I am experimenting with my likes, dislikes, and my personality, something that is not unlike other girls going through puberty.

Does HRT effect my ability to have children?
Assume the answer to this is yes... Talk to a doctor before starting HRT if you think you may want to have children in the future.

Wednesday, August 17, 2016

Female To Male Transsexual Surgery Options

There are a number of possible surgical procedures that female to male transsexual men seek out. Below is a simple overview. Each comes with their own risks so please talk to you doctor and therapist to determine if any are right for you.

Phalloplasty

Female To Male Transsexual Surgery Options In this procedure a combination of skin grafts, implants and urethral lengthening are used to create a penis. There are a few methods involving using skin from different areas but grafts are always required. There can be a number of complications including but not limited to infection, death of the grafted tissue, urethral fistula (a hole in the urethra), blog clots and scaring.

In regards to sexual function, erections are maintained by the insertion of either a rod (permanently or removable) or an inflatable pump.

I must be stated that the patient must be aware that there is great difficulty in preforming this surgery with truly outstanding cosmetic results. They must discuss this and all the risks before committing to surgery.

Scrotoplasty

In this procedure involves creating a scrotum out of existing tissue from the labia majora. Prosthetic testis are sometimes inserted afterward.

Hysterectomy

This is the surgical removal of the uterus. It is often done along with a procedure called a Oophorectomy. This is the technical term for the removal of the ovaries. This is considered major surgery and comes with it all of the associated risks. This includes infection, blood clots, adhesions, hemorrhage, bowel obstruction, urinary tract damage and death. Also, Removal of the ovaries may increase the risk of heart disease and / or osteoporosis.

Vaginectomy

This is the surgical removal of the vagina.

Mastectomy

This is probably the most common surgery sought out by trans men. It involves the surgical removal of the breasts. This is what is what people mean when they talk about Top Surgery for trans men.

Risks include but are not limited to infection, bleeding, numbness of the area where the breast used to be and scaring.

Male To Female Transsexual Surgery Options

There are a number of possible surgical procedures that male to female transsexual women seek out. Below is a simple overview. Each comes with their own risks so please talk to you doctor and therapist to determine if any are right for you.

Vaginoplasty

Male To Female Transsexual Surgery Options For male to female transsexuals this is the surgery that is usually associated with the term "sex change" (A more correct term would be gender reassignment or sexual reassignment surgery).

The goal of this surgery is the creation of a fully functional vagina and clitoris using existing tissue (and possible skin graphs). During this surgery the testicles are removed and the penile skin is folded inward to create the vagina. The scrotal skin is used in the creating of the labia and the glands of the penis is used to create the clitoris. It is the goal and usual outcome that feeling and sexual arousal are maintained for individuals after undergoing this surgery.

Many surgeons require some amount of preoperative hair removal from the penile shaft, scrotum or both. This prevents hair from growing inside the newly constructed vagina. Also, after the surgery is completed the patient will have to dilate their vagina to prevent shrinkage and or collapse.

There are fairly strict rules on who is eligible for this surgery and what requirements they must fulfill to meet this eligibility. For the most part the patient must be of legal age, they have to have been on hormones for a year (if medically able to), they must have lived at least 12 months in a female gender role, they must have a have a therapist, they must understand the cost and ramifications as well as understand their options and they must know of more then one surgeon who can preform the surgery. While controversial the purpose of these restrictions are said to protect the patient (I do not agree 100% but this isn't an opinion piece).

For a better description of these requirements see the World Professional Association for Transgender Health's Standards of Care for Gender Identity Disorders

Possible Complications
The following is a non-exhaustive list of possible complications to the previous surgery. Note that no surgery is without risk.

For a vaginplasty this risks include possible irreparable damage to surrounding organs (prostate, bladder, etc), nerve damage and even death. The most common complications with a vaginaplasty according to my research are infection, bleeding, and scarring.

One major complication that must be noted is called a vaginal-rectal fistula. This is when a whole opens between the vagina and the rectum. While usually correctable this is a very serious complication that results in the person having to have a colostomy while the wound heals. Also because dilation may not be possible the newly constructed vagina may collapse resulting in the patient needing to undergo the whole gender reassignment surgery again.

Labiaplasty

This is usually step two in the gender reassignment surgery process. In this procedure the labia is created or reshaped. This is usually an outpatient procedure done under local anesthesia. Side effects include infection, bleeding, decrease feeling and discomfort.

Orchiectomy

This surgery involves the removal of the testicles. It can be preformed as an outpatient procedure. Post surgery the patient will no longer produce male levels of testosterone. This may result in side effects that may include loss of bone mass, reduced libido, hot flashes, weight gain and loss of muscle mass; especially if the patient is not taking estrogen.

Breast Augmentation

This is pretty much the same as breast implant surgery for cissexual women. The difference is this, it is recommended that the transsexual patient waits until breast development has stopped. The reason for this is that if the implants are inserted before breast development completes future development may move the implants around and sometime cause noticeable breast deformity.

Again, the standards of care sets requirements for breast augmentation in male to female transsexuals.

Other Procedures

Other surgeries include facial feminization (tracheal shaving, brow reduction, and jaw bone reduction), as well as liposuction. These surgeries are not without risk and are usually extremely painful. Like with any of the above procedures, careful consideration should be used when considering these options.

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